Community based estimation of perinatal mortality through record linkage.

MedLine Citation:

PMID:
8979583
Owner:
NLM
Status:
MEDLINE

Abstract/OtherAbstract:

OBJECTIVE: To estimate perinatal mortality through record linkage of Health Workers (HW) and Anganwadi Workers (AWW) in rural Haryana. DESIGN: Retrospective analysis of records (1991-92) of HW and AWW. Enquiry and home visits were made for tracing the fate of pregnancy in cases with incomplete records. SETTING: In 1993-95 in 45 villages selected purposively in Raipur Rani block, Ambala. MAIN OUTCOME MEASURE: Enlisting of perinatal deaths as the main outcome measure through scrutiny of records of HW and AWW. RESULTS: Perinatal mortality rate (PMR) was 42.25 and 45.78 per thousand births as per the record of HW and AWW, respectively for the 23 villages for whom records of both were available. Support by enquiry or home visit yielded a PMR of 59.42 for combined HW and AWW sources and 51.66 per 1000 births for AWW source alone. Concordance between AWW and HW records for fate of pregnancy was moderate (K = 0.46; 95% CI 0.35-0.57). CONCLUSIONS: There is a lack of a system of record linkage between and within the records of HW and AWW at primary health care level. AWW data was more accurate and up-to-date as compared to HW. Reasonably accurate estimates of perinatal mortality rate can be made through record linkage.In India, October 1991-September 1992 data were abstracted from records on pregnant women, postpartum cases, and infants' immunization status procured from health workers (HWs) and Anganwadi workers (AWWs) working in 23 villages of Raipur Rani block, Ambala, in Haryana State. Home visits and enquiry were conducted to learn pregnancy outcomes in cases with incomplete records. The purpose was to determine whether the record linkage approach is a feasible means to estimate the perinatal mortality rate (PMR). Among the 1954 pregnancies registered by either an AWW or HW, both AWWs and HWs had information available on only 510 (26%) cases. HW and AWW records agreed on outcome of 431 (84.5%) of the 510 pregnancies (Kappa = 0.46 for agreement [i.e., moderate agreement]). Among the remaining pregnancies, AWWs had more information than HWs (46% vs. 28%). The PMR estimated from AWW records alone or from combined HW and AWW sources was higher than that estimated from HW records alone (51.66 and 49.18, respectively vs. 10.9/1000 births), but the difference was not statistically significant. For both AWWs and HWs, live birth outcomes were more likely to be recorded than still births or early neonatal deaths (97.8% vs. 72%) and less likely to be determined via enquiry or home visits (2.2% vs. 28%) (p 0.001). The same pattern was true for AWWs alone (95.6% vs. 57% and 2.4% vs. 43%, respectively; p 0.001). HWs were more likely not to record pregnancy outcomes than AWWs (16-17% vs. 8-9%). These findings indicate no record linkage system between the records of HWs and AWWs at the primary health care level and that AWW data were more accurate and up-to-date than HW data.